Did You Know? Anticholinergics

Jan 6, 2021 | Clinical Insight

Conditions Treated by Anticholinergics

Anticholinergic drugs are used to treat a variety of conditions, including chronic obstructive pulmonary disease (COPD), bladder conditions, allergies, gastrointestinal disorders, and symptoms of Parkinson’s disease.  This blog post covers what anticholinergics are, how they work, categorical and numerical scoring, and adverse effects.

What Anticholinergics Are and How They Work

Anticholinergics are a type of medication that block the action of a brain chemical messenger, acetylcholine. Acetylcholine is responsible for regulating/transmitting signals that are specific for body functions. This includes skeletal muscles and smooth muscles found in the heart, stomach, intestines, urinary tract, and lungs. The cells involved in the contraction of these muscles have receptors and these receptors are responsible for binding acetylcholine. Once cholinergic receptors are active, we get the “anticholinergic effect.” In general, this term refers to anticholinergic drugs blocking acetylcholine binding to cholinergic receptors during abnormal muscle function, providing alleviation.

By reaching therapeutic goals, we need to achieve the “anticholinergic effect.” For example, someone who experiences breathing restrictions associated with asthma or COPD, blocking cholinergic receptors in the lungs can provide relief and improve airflow. 

On the other hand, there are drugs in this class that provide an unintended “anticholinergic effect.” These include, antidepressants and antipsychotics, which either increase or decrease serotonin in the brain to alter someone’s mood/behavior. Altered levels of brain hormones can lead to unwanted side effects.

Categorical and Numerical Scoring

Below is a list of anticholinergics that are commonly used in a long-term care.  The number following the medication name is the categorical score.  A score of 2 or 3 = definite anticholinergics, a score of 1 = possible anticholinergic.  To calculate the numerical score, add the score contributed to each selected medication in each category, add the number of possible or definite medications.

  • Amitriptyline (Elavil) – 3
  • Clozapine (Clozaril)- 3
  • Diphenhydramine (Benadryl) – 3
  • Doxepin (Sinequan)- 3           
  • Hydroxyzine (Atarax, Vistaril) – 3
  • Meclizine (Antivert) – 3
  • Methocarbamol (Robaxin)- 3
  • Oxybutynin (Ditropan)- 3
  • Paroxetine (Paxil)- 3
  • Promethazine (Phenergan)- 3
  • Quetiapine (Seroquel)- 3
  • Solifenacin (Vesicare)- 3
  • Tolterodine (Detrol) – 3
  • Amantadine (Symmetrel)-2
  • Carbamazepine (Tegretol) – 2
  • Cyclobenzaprine (Flexeril) -2
  • Alprazolam (Xanax) – 1
  • Cetirizine (Zyrtec) – 1
  • Morphine (MS Contin, Avinza) – 1
  • Trazodone (Desyrel) – 1

Warnings and Adverse Effects

The most common adverse effects are: blurred vision, constipation, dry mouth, urinary retention, tachycardia, and agitation.

  • ***WARNING: Use ALL anticholinergic medications with EXTREME caution in patients >65 years of age (BEER’s List)
  • *NOTE: Avoid use in elderly with certain medications

Each definite anticholinergic may increase the risk of cognitive impairment by 46% over 6 years. For each one-point increase in the total Anticholinergic Cognitive Burden Scale, a decline in MMSE score of 0.33 points over 2 years has been suggested. In addition, each one-point increase in the ACB total score has been correlated with a 26% increase in the risk of death.

If a resident is experiencing anticholinergic side effects, the provider should be notified so these effects are assessed and a discontinuation/change to the causative medication is issued as soon as possible.

Additional Resources

Visit: https://www.uea.ac.uk/documents/746480/2855738/Anticholinergics.pdf if you would like to see the full document.

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Brandi VanValkenburg

Brandi provides personalized care as a pharmacy consultant with HealthDirect's northeastern region.  She has been serving our clients for over 10 years. 

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